The cardiologist says it's "concerning" that in the United States, there's been a one to two per cent increase of heart disease in women between the ages of 35 and 50, while, for men, the numbers have decreased by the same amount.

The Rochester, Minn., based Mulvagh -- who originally hails from Ottawa -- was in Winnipeg last week to speak at Heart of a Woman, a conference about cardiovascular health.

Here's some of my conversation with the effervescent cardiologist, marathon runner and advocate for a strong heart:

FP: Why are women so susceptible to heart disease?

SM: It's really a very topical issue right now. There's just been another release of information that women in mid-life have shorter longevity than men. It probably has a lot to do with lifestyle, poor diet, lack of exercise, obesity, education factors.

FP: You mentioned that heart attack symptoms in women are different than those in men. What are the differences?

SM: In 59 per cent of women in a huge study of over one million people, (women) had classic chest pain when they presented with a heart attack compared with 70 per cent of men.

But in addition, they are more likely to have the symptoms of shortness of breath and pain that's elsewhere -- in the jaw or neck or shoulder as well as nausea, vomiting, sweatiness... and fatigue.

FP: Is Aspirin always the right thing to take if you think you're having a heart attack?

SM: Yes. Very rarely would it be a problem. In almost all cases it is the right thing to do. The general recommendation is call 911, take 325 milligrams of Aspirin -- four baby Aspirin or one regular Aspirin. Chew it because it gets absorbed more quickly.

FP: You've been studying the role of glucose and insulin on heart disease. What is the connection?

SM: We're looking at the impact of different levels of glucose in the body, normal and high. The effect acutely on coronary blood flow reserve -- that's the delivery of blood to the heart muscle. We found that coronary blood flow decreases when the blood sugar is higher.

FP: So, you were looking at patients with Type 1 and Type 2 diabetes?

SM: No. Just Type 2. And non-diabetics.

FP: So, is it fair to say that the more carbohydrates a person eats, the higher the risk for heart disease? In other words, can we assume that even a momentary elevation in blood sugar in someone who doesn't have diabetes is at risk?

SM: Sure. Because we don't really know. Glucose intolerance, particularly for those who have localized abdominal fat, seem to be more at risk for heart disease than the general obese person. High triglycerides. Increased abdominal girth. It certainly could be that the constant exposure to more refined carbohydrates could be doing that.

FP: In light of this information, what's the biggest enemy in heart disease? Is it saturated fat or refined carbohydrates?

SM: That's the $50 million question. I think what the important thing is following a diet like the Mediterranean diet, where the saturated fats are low but the unsaturated fats are high and the carbohydrates include a lot of fibre. It really is the way to go. I tell my patients avoid starchy white things. Saturated fats, meaning fats that come from animal products, that's really the wrong kind of diet to have.

And what the American Heart Association did by (telling people to eat) a low-fat diet was the wrong thing to do. I think we all agree on that now (because everybody filled in with a bunch of carbohydrates).

FP: Here's Canada's Food Guide. I'm sure it's similar to the American food pyramid. Some critics say Canada's guide recommends too many carbohydrates, even though a lot of them whole grain, because even whole grains can substantially raise blood sugar levels. What's your opinion?

SM: It's good that they are recommending fruits and vegetables, but they put grain products (high) up there, too. Olive oil and nuts should be a bigger deal. And you should be eating fish more often -- and meat just intermittently. This is just wrong. (They should recommend only) skim milk (and not higher fat dairy).

FP: Should we be afraid of fat?

SM: Saturated fat. Unsaturated fat are calories, but they are good calories.

FP: How do unsaturated fats help our hearts?

SM: They protect the lining on the blood vessels. Certainly, they bring down triglycerides.

FP: You're a runner. How many marathons have you run?

SM: Seven. I didn't start running until later. I always ran just because it made me feel better, especially during medical school. Going for a run is the equal to about two cups of coffee for me. And it's like money in the bank. You've made your investment for the day. And it's only going to grow. And it stays with you.

FP: You emphasize the importance of exercise in preventing heart disease. Is extreme exercise such as marathon running healthy for the heart?

SM: Any activity that you do, it's important to listen to your body. If you do have risk factors for heart disease, make sure they are under control.

FP: How do we make sure we don't have risk factors?

SM: Talk with your physician and take control of your own health. Demand that the doctor pay attention to your heart health and risk factors.

Have an interesting story idea you'd like Shamona to write about? Contact her at shamona.harnett@freepress.mb.ca.

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